建立综合医院精神疾病诊疗管理体系的探讨

EXPLORE INTO THE ESTABLISHMENT OF MENTAL ILLNESS TREATMENT MANAGEMENT SYSTEM IN COMPREHENSIVE HOSPITAL

目的了解目前综合医院对精神疾病诊疗过程中出现的一些医学伦理问题,针对问题提出处理建议。方法成立医院精神疾病诊疗伦理监控小组,对近3年我院心理科、神经内科、心内科、消化内科门诊及病房精神疾病患者诊疗过程进行监控。随机分组,A组为诊疗质量监控组,B组为非诊疗质量监控组。从脱落率、误诊率、治疗前后汉密尔顿抑郁评分及汉密尔顿焦虑评分进行对比。结果 A组脱落率较B组低,有统计学差异,误诊率无统计学差异。从汉密尔顿抑郁评分及汉密尔顿焦虑评分对比判断受监控组患者治疗效果较佳。结论建立完善的精神疾病就诊制度,是否尊重病人的健康权、自主权、知情权、隐私权、资料权等伦理问题对精神疾病诊治很重要。

Objective To understand the medical ethics problems in the process of diagnosing and treating the mental disea- ses in comprehensive hospitals and to put forward some suggestions. Methods Establish ethical monitoring group of mental illness, monitor the clinical process of the psychological patients who were treated in the department of psychology, neurology, cardiology, gas- troenterology in recent 3 years. The patients were randomized into two groups： the quality monitored group （ group A） and the quality unmonitored group （group B ）. Compare the misdiagnosis rate, loss rate, the Hamilton depression score and the Hamilton anxiety score of two groups. Results The loss rate of group A was lower than group B and there was a significant difference between two groups, there was no statistical difference in the misdiagnosis. The Hamilton depression score and the Hamilton anxiety score of the monitored group was better than unmonitored group. Conclusion It is important to establish mental diseases diagnosis system and be aware of the patient＇s ethical problems, such as health rights, autonomy, right to knowing, right of privacy, right of information.